Contraceptives That Don't Quit

Contraceptives That Don't Quit

Norplants protects for five years, yet Depo-Provera is winning more fans

In 1990, when the Food and Drug Administration approved a new contraceptive known as Norplant for use in the United States, many assumed that the new product would join birth control pills and condoms as one of the dominant forms of contraception in America.

Similar to birth control pills  in its chemical makeup, the Norplant device provides highly reliable, reversible contraceptive protection for up to five years. But reported difficulties with the removal of Norplant, which is a contraceptive implant that goes into the underside of a woman's upper arm, and controversy about potential side effects have quieted much of the early enthusiasm for the drug. Instead, another approved hormonal contraceptive, Depo-Provera, which is taken by injection and provides about 14 weeks of protection per treatment, is winning wider approval from American women. 

Both Norplant and Depo-Provera are based on progestin, a synthetic version of the hormone progesterone that the body produces during menstruation. Progestin protects against pregnancy by inhibiting ovulation, impeding fertilization, and the endometrium (the lining of the uterus), making implantation of a fertilized egg very difficult.

Both Norplant and Depo-Provera are considered over 99 percent effective in preventing pregnancy when administered correctly, but the way they work is very different. Norplant delivers its dosage by employing a series of six matchstick-sized time-released capsules that must be surgically implanted into a woman's upper arm using local anesthesia. If inserted during the first seven days of the menstrual cycle, it becomes effective within 24 hours.

A child with a flower. Sketch by Elena

Depo-Provera is injected, rather than implanted, into the muscle of a woman's buttock or an upper arm. The treatment is administered every twelve weeks to ensure that protection from the previous injection has not yet worn off. Fertility may take several months to return to a woman discounting Depo-Provera, but more than three-quarters of women who stop in order to conceive become pregnant within 12 months, and more than 90 percent succeed within two years.

The side-effects of both Norplan and Depo-Provera are similar to those of women taking the pill. They can include irregular menstrual bleeding and spotting, weight fluctuations both up and down, breast tenderness, headaches, hair loss, and dizziness at times. But unlike Norplant, whose effects can be quickly reversed in a woman experiencing side effects until the shot's 14-week cycle has run its course.

Norplant's greatest appeal may be for women who have finished their childbearing but do not wish to undergo sterilization, and for those whose health conditions preclude the use of the Pill or other birth control measures. It is inappropriate for women who are breast-feeding during their first six weeks after delivery or have unexplained vaginal bleeding, blood clots, inflammation of the veins, or a serious liver disease. It is also off-limits to women with a history of breast cancer.

Depo-Provera is not recommended for pregnant women because of a possible link to premature birth. But, unlike Norplant, there is no restriction on use by women who are breast-feeding.

Birth techniques may appeal to women who seek a highly reliable – and highly private – contraceptive method. Depo-Provera requires more frequent visits to a doctor or clinic for treatment, but at about $35 per shot and usually no more than $47 to $80 for a pre-shot examination, it is less of a financial burden than Norplant, which costs between $500 and $750 for insertion by a trained practitioner and another $50 to $150 for removal.

Norplant has been plagued by two other major complaints by users as well. One has been charges, unsubstantiated by scientific studies, that Norplant contributes to everything from strokes to cancer to autoimmune diseases. The drug's manufacturer Wyeth-Ayrest, revised its labeling to acknowledge that adverse reactions have been reported since the product went on the market, but noted, with the FDA's approval, that health problems, such as strokes, thrombosis, and heart attack, that have stricken Norplant users on occasion could be entirely coincidental and have nothing to do with the fact that the woman may have been a Norplant user.

Even more controversial have been the difficulties that some women have experienced during the removal of their implants from just below the skin. Because of problems in some physicians' training and techniques for inserting and removing the hormonal rods, some patients report the procedure proved unexpectedly painful and resulted in unsightly scarring. A number of class-action lawsuits have been filed and are being vigorously contested by the manufacturer, but the adverse publicity appears to have slowed the product's acceptance markedly.

Still, properly implanted and removed by trained medical personnel, Norplant has much to recommend for women seeking reliable, long-term, reversible birth control that demands very little involvement on their part on mouth to mouth. For women wanting something less than five years' protection from a single implant, Norplant's manufacturer is also developing Norplant II, which would use just two rods to provide up to three years' protection.

Birth Control by the numbers

Sterilization is the most frequently used contraceptive technique in the U.S. Method and percent of women who use it:

For women – PIII – 25%. Spermicides (foams, creams, gels) – 6%. Diaphragm/Cervical Cap – 5.7%. Springs – 1.1%. Implants (Norplant) – 1%. IUD – 1%. For men and women – Sterilization/ Tubal ligation – 27%. Condoms – 19%. Withdrawl/rythm – 7%.